Feasibility of the HEAR-aware App for Hearing Loss Self-Management: A Nonrandomized Intervention Study to Examine Intervention Acceptability and the Stages-of-Change Concept

OBJECTIVES

The HEAR-aware project targets adults ≥50 years who were recently diagnosed with hearing loss and declined hearing aids, but were open for support via a smartphone app on different target behaviors (TBs). The HEAR-aware app, based on Ecological Momentary Assessment and Ecological Momentary Intervention (EMA, EMI), contains educational materials ("snippets") tailored partly to the user's experienced listening situations. The app aims to increase adults' TB-specific readiness to take action on hearing problems. The present study focused on examining feasibility regarding three novel aspects: (1) the app's acceptability, mainly regarding its EMA and EMI elements (compliance, usability, usefulness, satisfaction), (2) psychometric properties of 10 new TB-specific stages-of-change (SoC) measures (test-retest reliability, construct validity), and (3) the potential of tailoring snippets on a person's SoC.

DESIGN

A nonrandomized intervention study including four measurements with 2-week intervals (T0-T3). (1) The intervention period lasted 4 weeks. App usage data were collected throughout (T1-T3). Usability, usefulness, and satisfaction were measured at T3 (n = 26). (2) Reliability concerned T0 and T1 data, in between which no intervention occurred. Intraclass correlation coefficients (ICCs) were calculated (n = 29). Construct validity was examined by calculating correlations between the different TB-specific scales (at T0), and also between each of them and self-reported hearing disability (n = 29). (3) Person-tailoring by SoC was examined using T0 and T1 data. Linear mixed models were applied to test whether users rated snippets corresponding to their SoC as more interesting and useful than noncorresponding snippets (n = 25).

RESULTS

(1) The percentage of participants that complied with the intended usage varied across the five predefined compliance criteria (lowest: 8%; highest: 85%). Median snippet satisfaction scores were reasonably positive (3.5 to 4.0 of 5). Usability was good (System Usability Score, mean = 72.4, SD = 14.3) and usefulness satisfactory (Intrinsic Motivation Inventory, mean = 4.4, SD = 1.4), but showed large variance. (2) The 10 TB-specific scales showed fair-to-excellent reliabilities (range ICCs = 0.51 to 0.80). Correlations between the TB-specific scales ranged between -0.17 ( p > 0.05) and 0.74 ( p < 0.001), supporting only partly overlap between their underlying constructs. Only the correlation between TB-specific readiness for hearing aid uptake and self-reported hearing disability was significant. (3) Correspondence of a snippet's SoC with the person's SoC significantly related to "interesting" ratings ( p = 0.006). Unexpectedly, for snippets with a lower SoC than the participant's, further deviation of the snippet's SoC from the participant's SoC, increased the participant's interest in the snippet. The relationship with "usefulness" was borderline significant.

CONCLUSIONS

(1) Overall usability, usefulness, and satisfaction scores indicated sufficient app acceptability. The high variance and fairly low compliance showed room for improving the app's EMA/EMI parts for part of the participants. (2) The 10 new TB-specific SoC measures showed sufficient reliability, supporting that they measured different types of readiness to take action on hearing problems (construct validity). (3) The unexpected findings regarding tailoring educational app materials to individuals' SoC deserve further study.

Rationale, Theoretical Underpinnings, and Design of HEAR-aware: Providing Adults With Hearing Loss With Tailored Support to Self-Manage Their Hearing Problems via a Smartphone App, as an Alternative to Hearing Aids

Purpose An alarming two thirds of adults aged 50 years or over with hearing impairment who could benefit from hearing aids do not own any, leaving these adults with no support to self-manage their hearing problems. In the HEAR-aware project, it is hypothesized that self-management can be facilitated via a smartphone app if its educational content is tailored to a person's dynamic stage of readiness to take action on their hearing (stage of change) and to a person's dynamic acoustical situations (as measured via a wearable microphone) and associated challenges (as captured via ecological momentary assessment). As such, the HEAR-aware app would be an ecological momentary intervention. This research note describes the rationale and theoretical underpinnings of the app, as well as the rationale for planning a series of studies to develop and evaluate it. Study Designs After a preparatory phase, Study 1 includes qualitative group interviews to assess user needs. Next, a creative session will be held, in which all stakeholders involved will work toward a specified version of the app. Subsequently, prototypes of the app will be developed and pilot-tested (Pilot Studies 2A and 2B). Users' usage and ratings (usability and quality indicators) of the app's elements will be examined and processed in the app. Lastly, the effectiveness of the app's final version will be examined in a randomized controlled trial (Study 3). Discussion The project's merits and challenges will be discussed.

Predictors of Purchasing a Hearing Aid After an Evaluation Period: A Prospective Study in Dutch Older Hearing Aid Candidates

Purpose The current study aimed to identify factors that distinguish between older (50+ years) hearing aid (HA) candidates who do and do not purchase HAs after having gone through an HA evaluation period (HAEP). Method Secondary data analysis of the SUpport PRogram trial was performed (n = 267 older, 1st-time HA candidates). All SUpport PRogram participants started an HAEP shortly after study enrollment. Decision to purchase an HA by the end of the HAEP was the outcome of interest of the current study. Participants' baseline covariates (22 in total) were included as candidate predictors. Multivariable logistic regression modeling (backward selection and reclassification tables) was used. Results Of all candidate predictors, only pure-tone average (average of 1, 2, and 4 kHz) hearing loss emerged as a significant predictor (odds ratio = 1.03, 95% confidence interval [1.03, 1.17]). Model performance was weak (Nagelkerke R ² = .04, area under the curve = 0.61). Conclusions These data suggest that, once HA candidates have decided to enter an HAEP, factors measured early in the help-seeking journey do not predict well who will and will not purchase an HA. Instead, factors that act during the HAEP may hold this predictive value. This should be examined.

Innovation in the Context of Audiology and in the Context of the Internet

PURPOSE

This article explores different meanings of innovation within the context of audiology and the Internet. Case studies are used to illustrate and elaborate on the new types of innovation and their levels of impact.

METHOD

The article defines innovation, providing case studies illustrating a taxonomy of innovation types.

RESULTS

Innovation ranges from minor changes in technology implemented on existing platforms to radical or disruptive changes that provide exceptional benefits and transform markets. Innovations within the context of audiology and the Internet can be found across that range. The case studies presented demonstrate that innovations in hearing care can span across a number of innovation types and levels of impact. Considering the global need for improved access and efficiency in hearing care, innovations that demonstrate a sustainable impact on a large scale, with the potential to rapidly upscale this impact, should be prioritized.

CONCLUSIONS

It is unclear presently what types of innovations are likely to have the most profound impacts on audiology in the coming years. In the best case, they will lead to more efficient, effective, and widespread availability of hearing health on a global scale.

Verbal Response Times as a Potential Indicator of Cognitive Load During Conventional Speech Audiometry With Matrix Sentences

This study examined verbal response times-that is, the duration from stimulus offset to voice onset-as a potential measure of cognitive load during conventional testing of speech-in-noise understanding. Response times were compared with a measure of perceived effort as assessed by listening effort scaling. Three listener groups differing in age and hearing status participated in the study. Testing was done at two target intelligibility levels (80%, 95%) and with two noise types (stationary and fluctuating). Verbal response times reflected effects of intelligibility level, noise type, and listener group. Response times were shorter for 95% compared with 80% target intelligibility, shorter for fluctuating compared with stationary noise, and shorter for young listeners compared with older listeners. Responses were also faster for the older listeners with near normal hearing compared with the older hearing-aid users. In contrast, subjective listening effort scaling predominantly revealed effects of target intelligibility level but did not show consistent noise-type or listener-group effects. These findings show that verbal response times and effort scalings tap into different domains of listening effort. Verbal response times can be easily assessed during conventional speech audiometry and have the potential to show effects beyond performance measures and subjective effort estimates.

Behavioral Assessment of Listening Effort Using a Dual-Task Paradigm

Published investigations (n = 29) in which a dual-task experimental paradigm was employed to measure listening effort during speech understanding in younger and older adults were reviewed. A summary of the main findings reported in the articles is provided with respect to the participants’ age-group and hearing status. Effects of different signal characteristics, such as the test modality, on dual-task outcomes are evaluated, and associations with cognitive abilities and self-report measures of listening effort are described. Then, several procedural issues associated with the use of dual-task experiment paradigms are discussed. Finally, some issues that warrant future research are addressed. The review revealed large variability in the dual-task experimental paradigms that have been used to measure the listening effort expended during speech understanding. The differences in experimental procedures used across studies make it difficult to draw firm conclusions concerning the optimal choice of dual-task paradigm or the sensitivity of specific paradigms to different types of experimental manipulations. In general, the analysis confirmed that dual-task paradigms have been used successfully to measure differences in effort under different experimental conditions, in both younger and older adults. Several research questions that warrant further investigation in order to better understand and characterize the intricacies of dual-task paradigms were identified.

Next-generation sequencing technologies and their application to the study and control of bacterial infections

BACKGROUND

With the efficiency and the decreasing cost of next-generation sequencing, the technology is being rapidly introduced into clinical and public health laboratory practice.

AIMS

The historical background and principles of first-, second- and third-generation sequencing are described, as are the characteristics of the most commonly used sequencing instruments.

SOURCES

Peer-reviewed literature, white papers and meeting reports.

CONTENT AND IMPLICATIONS

Next-generation sequencing is a technology that could potentially replace many traditional microbiological workflows, providing clinicians and public health specialists with more actionable information than hitherto achievable. Examples of the clinical and public health uses of the technology are provided. The challenge of comparability of different sequencing platforms is discussed. Finally, the future directions of the technology integrating it with laboratory management and public health surveillance systems, and moving it towards performing sequencing directly from the clinical specimen (metagenomics), could lead to yet another fundamental transformation of clinical diagnostics and public health surveillance.

How linguistic closure and verbal working memory relate to speech recognition in noise--a review

The ability to recognize masked speech, commonly measured with a speech reception threshold (SRT) test, is associated with cognitive processing abilities. Two cognitive factors frequently assessed in speech recognition research are the capacity of working memory (WM), measured by means of a reading span (Rspan) or listening span (Lspan) test, and the ability to read masked text (linguistic closure), measured by the text reception threshold (TRT). The current article provides a review of recent hearing research that examined the relationship of TRT and WM span to SRTs in various maskers. Furthermore, modality differences in WM capacity assessed with the Rspan compared to the Lspan test were examined and related to speech recognition abilities in an experimental study with young adults with normal hearing (NH). Span scores were strongly associated with each other, but were higher in the auditory modality. The results of the reviewed studies suggest that TRT and WM span are related to each other, but differ in their relationships with SRT performance. In NH adults of middle age or older, both TRT and Rspan were associated with SRTs in speech maskers, whereas TRT better predicted speech recognition in fluctuating nonspeech maskers. The associations with SRTs in steady-state noise were inconclusive for both measures. WM span was positively related to benefit from contextual information in speech recognition, but better TRTs related to less interference from unrelated cues. Data for individuals with impaired hearing are limited, but larger WM span seems to give a general advantage in various listening situations.

New measures of masked text recognition in relation to speech-in-noise perception and their associations with age and cognitive abilities

PURPOSE

In this research, the authors aimed to increase the analogy between Text Reception Threshold (TRT; Zekveld, George, Kramer, Goverts, & Houtgast, 2007) and Speech Reception Threshold (SRT; Plomp & Mimpen, 1979) and to examine the TRT's value in estimating cognitive abilities that are important for speech comprehension in noise.

METHOD

The authors administered 5 TRT versions, SRT tests in stationary (SRT(STAT)) and modulated (SRT(MOD)) noise, and 2 cognitive tests: a reading span (RSpan) test for working memory capacity and a letter-digit substitution test for information-processing speed. Fifty-five adults with normal hearing (18-78 years, M = 44 years) participated. The authors examined mutual associations of the tests and their predictive value for the SRTs with correlation and linear regression analyses.

RESULTS

SRTs and TRTs were well associated, also when controlling for age. Correlations for the SRT(STAT) were generally lower than for the SRT(MOD.) The cognitive tests were correlated to the SRTs only when age was not controlled for. Age and the TRTs were the only significant predictors of SRT(MOD). SRT(STAT) was predicted by level of education and some of the TRT versions.

CONCLUSIONS

TRTs and SRTs are robustly associated, nearly independent of age. The association between SRTs and RSpan is largely age dependent. The TRT test and the RSpan test measure different nonauditory components of linguistic processing relevant for speech perception in noise.

Comparison of multiple-locus variable-number tandem repeat analysis, pulsed-field gel electrophoresis, and phage typing for subtype analysis of Salmonella enterica serotype Enteritidis

Strain subtyping is an important tool for detection of outbreaks caused by Salmonella enterica serotype Enteritidis. Current subtyping methods, however, yield less than optimal subtype discrimination. In this study, we describe the development and evaluation of a multiple-locus variable-number tandem repeat analysis (MLVA) method for subtyping Salmonella serotype Enteritidis. The discrimination ability and epidemiological concordance of MLVA were compared with those of pulsed-field gel electrophoresis (PFGE) and phage typing. MLVA provided greater discrimination among non-epidemiologically linked isolates than did PFGE or phage typing. Epidemiologic concordance was evaluated by typing 40 isolates from four food-borne disease outbreaks. MLVA, PFGE, and, to a lesser extent, phage typing exhibited consistent subtypes within an outbreak. MLVA was better able to differentiate isolates between the individual outbreaks than either PFGE or phage typing. The reproducibility of MLVA was evaluated by subtyping sequential isolates from an infected individual and by testing isolates following multiple passages and freeze-thaw cycles. PFGE and MLVA patterns were reproducible for isolates that were frozen and passaged multiple times. However, 2 of 12 sequential isolates obtained from an individual over the course of 36 days had an MLVA type that differed at one locus and one isolate had a different phage type. Overall, MLVA typing of Salmonella serotype Enteritidis had enhanced resolution, good reproducibility, and good epidemiological concordance. These results indicate that MLVA may be a useful tool for detection and investigation of outbreaks caused by Salmonella serotype Enteritidis.

Expression analysis of the family of 14-3-3 proteins in zebrafish development

14-3-3 proteins comprise a family of dimeric multi-functional proteins present in all eukaryotes, that are important in a whelm of ubiquitous biological processes. We have analyzed the genomic structure of all 14-3-3s from zebrafish comprising 11 genes and have analyzed their phylogeny. The gene family was cloned and its expression pattern in zebrafish embryogenesis was analyzed by whole mount in situ hybridization and microarray analysis with gene specific probes. We demonstrate that maternal mRNA of 14-3-3s is expressed evenly at the first cell division. At later stage all genes are expressed in a patterned way with, in most cases, intricate patterns in the developing brain. Our result shows distinct expression patterns of various genes. Microarray results show that differences in expression levels of highly similar 14-3-3 genes also occur in the adult stage.

Population-based incidence of pertussis among adolescents and adults, Minnesota, 1995-1996

To estimate the incidence of pertussis, a prospective study was done among members of a managed care organization in Minneapolis/St. Paul, Minnesota. Of 212 patients 10-49 years old enrolled from January 1995 through December 1996, 8 were found to be culture positive, 10 were found to be positive by polymerase chain reaction assay, 13 had a > or =2-fold increase in IgG or IgA to pertussis toxin (PT), and 18 had IgG to PT in a single serum specimen > or =3 SD above the mean of an age-matched control group. At least 1 positive laboratory test result for pertussis infection was found in 27 (13%) patients, among whom the duration of cough illness was a median of 42 days (range, 27-66 days). On the basis of any positive laboratory result, the estimated annual incidence of pertussis was 507 cases per 100,000 person-years (95% confidence interval, 307-706 cases). Bordetella pertussis infection may be a more common cause of cough illness among adolescents and adults than was recognized previously.

Evaluation of pulsed-field gel electrophoresis in epidemiological investigations of meningococcal disease outbreaks caused by Neisseria meningitidis serogroup C

Since 1990, the frequency of Neisseria meningitidis serogroup C (NMSC) outbreaks in the United States has increased. Based on multilocus enzyme electrophoresis (MEE), the current molecular subtyping standard, most of the NMSC outbreaks have been caused by isolates of several closely related electrophoretic types (ETs) within the ET-37 complex. We chose 66 isolates from four well-described NMSC outbreaks that occurred in the United States from 1993 to 1995 to evaluate the potential of pulsed-field gel electrophoresis (PFGE) to identify outbreak-related isolates specific for each of the four outbreaks and to differentiate between them and 50 sporadic isolates collected during the outbreak investigations or through active laboratory-based surveillance from 1989 to 1996. We tested all isolates collected during the outbreak investigations by four other molecular subtyping methods: MEE, ribotyping (ClaI), random amplified polymorphic DNA assay (two primers), and serotyping and serosubtyping. Among the 116 isolates, we observed 11 clusters of 39 NheI PFGE patterns. Excellent correlation between the PFGE and the epidemiological data was observed, with an overall sensitivity of 85% and specificity of 71% at the 95% pattern relatedness breakpoint using either 1.5 or 1.0% tolerance. For all four analyzed outbreaks, PFGE would have given public health officials additional support in declaring an outbreak and making appropriate public health decisions.

Characterization of gyrA mutations associated with fluoroquinolone resistance in Campylobacter coli by DNA sequence analysis and MAMA PCR

Increasing numbers of fluoroquinolone-resistant Campylobacter coli isolates received at the Minnesota State Public Health Laboratory and at the Centers for Disease Control and Prevention have been a cause for concern. The gyrA quinolone resistance-determining regions of several fluoroquinolone-resistant isolates were sequenced to examine the mechanism of resistance. Ciprofloxacin-resistant C. coli isolates examined by DNA sequencing had a Thr-86 to Ile (ACT-->ATT) gyrA mutation, leading to resistance to fluoroquinolone antibiotics. A mismatch amplification mutation assay polymerase chain reaction protocol was developed to detect this gyrA mutation.

Exclusive expression of the receptor tyrosine kinase MDK4 in skeletal muscle and the decidua

Mouse developmental kinase 4 (MDK4), a novel receptor tyrosine kinase (RTK), was identified via degenerate primer screening of mouse embryo cDNA. The mRNA encoding this RTK was found only in skeletal muscle of mouse embryos and the maternal decidua. Northern blot analysis predicted an mRNA transcript size of 6.1 kb. The amino acid sequence is most closely related to Torpedo RTK. Analysis of mRNA and protein content of C2C12 cells at different stages of the differentiation process revealed increasing levels of MDK4 during this process. Immunofluorescence data indicated that MDK4 protein production begins with myoblasts elongation and is maintained throughout myotube formation. MDK4 transcripts were furthermore detected in the decidua tissue surrounding young embryos. Since decidua cells also form syncytia, it is possible that MDK4 is involved in the formation, regulation, and/or maintenance of the polynucleated state.

Site-directed mutagenesis of the ferric uptake regulation gene of Escherichia coli

The 12 histidine and four cysteine residues of the Fur repressor of Escherichia coli were changed, respectively, to leucine and serine by site-directed mutagenesis of the fur gene. The affects of these mutations were measured in vivo by ligation of the mutated genes to a wild-type fur promoter followed by measurement of the ability of these plasmids to regulate expression of a lacZ fusion in the aerobactin operon. In vitro affects were assayed by insertion of the mutated genes in the expression vector pMON2064 attended by isolation of the altered Fur proteins and appraisal of their capacity to bind to operator DNA. The results suggest that cysteine residues at positions 92 and 95 are important for the activity of the Fur protein.